Joules And Drugs

Question 1

A-Fib/A-Flutter (Stable)

Answer 1

CCB
-Cardizem (Dilt)
0.25mg/kg slow IV push (over 5 min)
0.35mg/kg 2nd dose
Max single dose 20mg

Beta Bockers
-Metoprolol
5mg over 2-5 min q 5 min up to 3 doses.

Question 2

A-Fib (Unstable)

Answer 2

Synchronized Cardioversion

Consider sedation/pain management

Initial energy: 120-200j

Immediately increase energy in a step-wise fashion if no change on the monitor.

Repeat 200j PRN every 1-2 min

Question 3

A-Flutter (Unstable)

Answer 3

Consider sedation/pain management

Initial Energy: 50J

Increase in step-wise fashion if no change on the monitor

Repeat up to 200J every 1-2 min PRN

Question 4

Asystole

Answer 4

Pads

4 lead to confirm Asystole in lead 2

Continue CPR

IV/IO

Epi 1mg (0.1mg/mL) IV/IO q 3-5 min

Airway-Capnography

H’s & T’s

Transport/Terminate

Question 5

V-Fib/Pulseless V-Tach

Answer 5

Pads

Confirm pulselessness

Defibrillate 120-200J

Continue CPR

IV/IO

Epi 1mg (0.1mg/mL)

Amio 300mg IVP, 150mg 2nd dose

Airway-Capnography

H’s & T’s

Fluid

Drug-Shock-Drug-Shock pattern (alternate epi and antiarrhythmic)

Transport/Terminate

Question 6

Torsades (Pulse + Unstable)

Answer 6

Defibrillate at 120-200J
—Increase energy in Step-wise fashion
—Be prepared for patient to arrest

Mag Sulfate : 1-2g in 10+mL saline, slow IVP

Expert consultation

Transport

Question 7

Torsades (Pulse + Stable)

Answer 7

Mag Sulfate: 1-2g in 10+mL NS slow IVP

Pads

Expert consultation

Transport

Question 8

Torsades (Pulseless)

Answer 8

ACLS + Mag Sulfate 1-2mg in 10+mL NS slow IVP after the first epi.

Question 9

V-Tach (Pulse + Stable)

Answer 9

Amio: 150mg IV/IO over 10 min.
—Repeat once after 10 min.
—Maintenance infusion of 1mg/min

OR

Lido: 1-1.5 mg/kg IV every 3-5 min. Subsequent doses 1/2 initial dose. Max total dose 3mg/kg.
—Maintenance infusion of 1-4mg/min

Transport

Question 10

V-Tach (Pulse + Unstable)

Answer 10

Consider sedation/pain management

Synchronized Cardioversion:
-Initial Energy: 100J
-Increase in step-wise fashion if no changes on monitor

Amiodarone:
-150mg IV/IO over 10 min
-Repeat once after 10 min
-Maintenance Infusion 1mg/min for 6 hours

Transport

Question 11

PEA

Answer 11

Pads

CPR

IV/IO

Epi 1mg (0.1mg/mL) IV/IO q 3-5min

Airway-Capnography

H’s + T’s

Fluid

Transport/Terminate

Question 12

SVT (Stable)

Answer 12

Vagal Maneuvers

Adenosine: 6mg rapid IV push followed by 10-20mL flush
—2 additional doses available 12mg each

Consider rate control if adenosine is unsuccessful
-CCB
—Cardizem: 0.25mg/kg, repeat at 0.35mg/kg

-Beta-Blocker
—Metoprolol: 5mg over 2-5 min, every 5 min, up to 3 doses

Question 13

SVT (Unstable)

Answer 13

Consider sedation/pain management

Synchronized Cardioversion:
-Initial Energy: 100J
-Increase in step-wise fashion if no change on the monitor.

Transport

Question 14

1st Degree and 2nd Degree Type 1 Heart Blocks (Stable)

Answer 14

Atropine: 0.5-1mg IV/IO every 3-5 min up to 3mg

Question 15

Heart Blocks (Unstable)

Answer 15

Consider sedation/pain management

TCP:
-Set rate 0-80 bpm
-Starting at lowest available mA, slowly increase until mechanical capture.
-Confirm mechanical capture by palpating pulse

Epi infusion: 2-10 mcg/min

OR

Dopamine infusion: 2-10 mcg/kg/min

Consider BB OD
-Glucagon 5mg IV/IO over 3-5 min

Consider CCB OD
-Calcium Chloride 10% Solution: 20mg/kg IV/IO over 5-10 min max dose 1g (50kg pt maxes dose)

Transport

Question 16

H’s (6)

Answer 16

Hypovolemia

Hypoxia

Hydrogen Ion Excess (Acidosis)

Hypo/Hyperkalemia

Hypothermia

Hypoglycemia

Question 17

T’s (6)

Answer 17

Toxins

Tamponade

Tension Pneumothorax

Thrombosis (MI)

Thromboembolism (PE)

Trauma